Risks for Anaphylaxis With Intravenous Iron Formulations
Authors: Hanny Al-Samkari, John A. Glaspy, Robert T. Means, Glenn M. Chertow, Michael Auerbach
Journal: Annals of Internal Medicine (2022)

LettersNovember 2022Risks for Anaphylaxis With Intravenous Iron FormulationsHanny Al-Samkari, MD, John A. Glaspy, MD, Robert T. Means Jr., MD, Glenn M. Chertow, MD, MPH, Michael Auerbach, MDHanny Al-Samkari, MDMassachusetts General Hospital and Harvard Medical School, Boston, MassachusettsSearch for more papers by this author, John A. Glaspy, MDUniversity of California, Los Angeles, Los Angeles, CaliforniaSearch for more papers by this author, Robert T. Means Jr., MDEast Tennessee State University, Johnson City, TennesseeSearch for more papers by this author, Glenn M. Chertow, MD, MPHStanford University School of Medicine, Palo Alto, CaliforniaSearch for more papers by this author, Michael Auerbach, MDGeorgetown School of Medicine, Washington, DCSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L22-0282 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: We read with interest Dave and colleagues' article (1) on the risk for anaphylaxis with intravenous (IV) iron and would like to highlight several concerns.First, the most important flaw of this study is the inferential definition of anaphylaxis from administrative data. Dave and colleagues employed an algorithm that used surrogates for true anaphylaxis, such as administration of epinephrine (rather than such clinically accurate objective definitions as the presence of wheezing, stridor, shock, and/or increased serum tryptase levels). This algorithm almost certainly overestimates the incidence of anaphylaxis after IV iron administration. Infusion reactions to IV iron occur ...References1. Dave CV, Brittenham GM, Carson JL, et al. Risks for anaphylaxis with intravenous iron formulations. A retrospective cohort study. Ann Intern Med. 2022;175:656-64. [PMID: 35344378] doi:10.7326/M21-4009 LinkGoogle Scholar2. Szebeni J, Fishbane S, Hedenus M, et al. Hypersensitivity to intravenous iron: classification, terminology, mechanisms and management. Br J Pharmacol. 2015;172:5025-36. [PMID: 26265306] doi:10.1111/bph.13268 CrossrefMedlineGoogle Scholar3. Karki NR, Auerbach M. Single total dose infusion of ferumoxytol (1020 mg in 30 minutes) is an improved method of administration of intravenous iron [Letter]. Am J Hematol. 2019;94:E229-31. [PMID: 31155744] doi:10.1002/ajh.25548 CrossrefMedlineGoogle Scholar4. Wolf M, Rubin J, Achebe M, et al. Effects of iron isomaltoside vs ferric carboxymaltose on hypophosphatemia in iron-deficiency anemia: two randomized clinical trials. JAMA. 2020;323:432-43. [PMID: 32016310] doi:10.1001/jama.2019.22450 CrossrefMedlineGoogle Scholar5. Glaspy JA, Wolf M, Strauss WE. Intravenous iron-induced hypophosphatemia: an emerging syndrome. Adv Ther. 2021;38:3531-49. [PMID: 34053011] doi:10.1007/s12325-021-01770-2 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Massachusetts General Hospital and Harvard Medical School, Boston, MassachusettsUniversity of California, Los Angeles, Los Angeles, CaliforniaEast Tennessee State University, Johnson City, TennesseeStanford University School of Medicine, Palo Alto, CaliforniaGeorgetown School of Medicine, Washington, DCDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L22-0282. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRisks for Anaphylaxis With Intravenous Iron Formulations Chintan V. Dave , Gary M. Brittenham , Jeffrey L. Carson , and Soko Setoguchi Risks for Anaphylaxis With Intravenous Iron Formulations Chintan V. Dave , Gary M. Brittenham , Jeffrey L. Carson , and Soko Setoguchi Metrics November 2022Volume 175, Issue 11Page: W143KeywordsAdverse eventsAnaphylaxisConfidence intervalsDextranMedicarePenicillinPositive predictive valueRandomized trialsRelative riskSucrose ePublished: 15 November 2022 Issue Published: November 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...